1
|
Palmer AC, Ndubani P, Sauer M, Spielman KL, Hamangaba F, Moyo N, Munsanje B, Moss WJ, Sutcliffe CG. Food and water insecurity in households of children and adolescents living with HIV and receiving care in a rural Zambian hospital: A mixed-methods study. PLoS One 2024; 19:e0300033. [PMID: 38833483 PMCID: PMC11149834 DOI: 10.1371/journal.pone.0300033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 02/20/2024] [Indexed: 06/06/2024] Open
Abstract
Approximately 62,000 Zambian children are living with HIV. HIV care and treatment is generally more limited in rural areas, where a heavy reliance on rain-fed subsistence agriculture also places households at risk of food and water insecurity. We nested a mixed methods study with an explanatory sequential design in a clinical cohort of children and adolescents living with HIV (CHIV) in rural Zambia. We used validated questionnaires to assess household food and water insecurity and examined associations between indicators derived from those scales, household characteristics, and HIV treatment adherence and outcomes using log-binomial regression. We identified caregivers and older CHIV from food insecure households for in-depth interviews. Of 186 participants completing assessments, 72% lived in moderately or severely food insecure households and 2% in water insecure households. Food insecurity was more prevalent in households of lower socioeconomic status (80% vs. 59% for higher scores; p = 0.02) and where caregivers had completed primary (79%) vs. secondary school or higher (62%; p = 0.01). No other characteristics or outcomes were associated with food insecurity. Parents limited both the quality and quantity of foods they consumed to ensure food availability for their CHIV. Coping strategies included taking on piecework or gathering wild foods; livestock ownership was a potential buffer. Accessing sufficient clean water was less of a concern. During periods of drought or service interruption, participants travelled further for drinking water and accessed water for other purposes from alternative sources or reduced water use. Community contributions afforded some protection against service interruptions. Overall, while food insecurity was prevalent, strategies used by parents may have protected children from a measurable impact on HIV care or treatment outcomes. Reinforcing social protection programs by integrating livestock ownership and strengthening water infrastructure may further protect CHIV in the case of more extreme food or water system shocks.
Collapse
Affiliation(s)
- Amanda C. Palmer
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | | | - Molly Sauer
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Kathryn L. Spielman
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | | | | | | | - William J. Moss
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Catherine G. Sutcliffe
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| |
Collapse
|
2
|
Ameyaw EK, Nutor JJ, Okiring J, Yeboah I, Agbadi P, Getahun M, Agbadi W, Thompson RGA. The role of social support in antiretroviral therapy uptake and retention among pregnant and postpartum women living with HIV in the Greater Accra region of Ghana. BMC Public Health 2024; 24:540. [PMID: 38383341 PMCID: PMC10882784 DOI: 10.1186/s12889-024-18004-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 02/06/2024] [Indexed: 02/23/2024] Open
Abstract
INTRODUCTION The role of social support in antiretroviral therapy (ART) uptake and retention among pregnant and postpartum women in Ghana's capital, Accra, has received limited attention in the literature. This cross-sectional study extends existing knowledge by investigating the role of social support in ART adherence and retention among pregnant and postpartum women in Accra. METHODS We implemented a cross-sectional study in eleven (11) public health facilities. Convenience sampling approach was used to recruit 180 participants, out of which 176 with completed data were included in the study. ART adherence in the three months preceding the survey (termed consistent uptake), and ART retention were the outcomes of interest. Initial analysis included descriptive statistics characterized by frequencies and percentages to describe the study population. In model building, we included all variables that had p-values of 0.2 or lesser in the bivariate analysis to minimize negative confounding. Overall, a two-sided p-value of < 0.05 was considered statistically significant. Data were analyzed using Stata version 14.1 (College Station, TX). RESULTS In the multivariate model, we realized a lower odds trend between social support score and consistent ART adherence, however, this was insignificant. Similarly, both the univariate and multivariate models showed that social support has no relationship with ART retention. Meanwhile, urban residents had a higher prevalence of ART adherence (adjusted Prevalence ratio (aPR) = 2.04, CI = 1.12-3.73) relative to rural/peri-urban residents. As compared to those below age 30, women aged 30-34 (aPR = 0.58, CI = 0.34-0.98) and above 35 (aPR = 0.48, CI = 0.31-0.72) had lower prevalence of ART adherence Women who knew their partner's HIV status had lower prevalence of ART adherence compared to those who did not know (aPR = 0.62, CI = 0.43-0.91). Also, having a rival or co-wife was significantly associated with ART retention such that higher prevalence of ART adherence among women with rivals relative to those without rivals (aOR = 1.98, CI = 1.16-3.36). CONCLUSION Our study showed that social support does not play any essential role in ART adherence among the surveyed pregnant and postpartum women. Meanwhile, factors such as having a rival and being under the age of thirty play an instrumental role. The study has signaled the need for ART retention scale-up interventions to have a multi-pronged approach in order to identify the multitude of underlying factors, beyond social support, that enhance/impede efforts to achieve higher uptake and retention rates.
Collapse
Affiliation(s)
- Edward Kwabena Ameyaw
- Institute of Policy Studies and School of Graduate Studies, Lingnan University, Hong Kong, China
- Africa Interdisciplinary Research Institute, Accra, Ghana
- L & E Research Consult Ltd, Wa, Upper West Region, Ghana
| | - Jerry John Nutor
- Department of Family Health Care Nursing, School of Nursing, University of California San Francisco, San Francisco, CA, USA.
| | - Jaffer Okiring
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Isaac Yeboah
- Africa Interdisciplinary Research Institute, Accra, Ghana
- Institute of Work Employment and Society, University of Professional Studies, Accra, Ghana
| | - Pascal Agbadi
- Africa Interdisciplinary Research Institute, Accra, Ghana
- Department of Sociology and Social Science Policy, Lingnan University, Hong Kong, China
| | - Monica Getahun
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Wisdom Agbadi
- Africa Interdisciplinary Research Institute, Accra, Ghana
- Push Aid Africa, Accra, Ghana
| | - Rachel G A Thompson
- Africa Interdisciplinary Research Institute, Accra, Ghana
- Language Center, College of Humanities, University of Ghana, Accra, Ghana
| |
Collapse
|
3
|
Nutor JJ, Okiring J, Yeboah I, Thompson RGA, Agbadi P, Ameyaw EK, Getahun M, Agbadi W, Hoffmann TJ, Weiser SD. Association between water insecurity and antiretroviral therapy adherence among pregnant and postpartum women in Greater Accra region of Ghana. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002747. [PMID: 38190403 PMCID: PMC10773961 DOI: 10.1371/journal.pgph.0002747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 11/30/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND Adherence to antiretroviral therapy (ART) can substantially reduce morbidity and mortality among women living with HIV (WLWH) and prevent vertical transmission of HIV. However, in sub-Saharan Africa (SSA), more than 50% of new mothers discontinue ART and HIV care after childbirth. The role of water insecurity (WI) in ART adherence is not well-explored. We examined the relationship between WI and ART adherence among pregnant and postpartum WLWH in Greater Accra region of Ghana. METHODS Using a cross-sectional survey, we recruited 176 pregnant and postpartum WLWH on ART across 11 health facilities. We examined the association between WI (measured using the Household Water Insecurity Experience Scale, and categorized as moderate and severe WI compard to low WI) and poor ART adherence (defined as scoring a below average observed CASE index score). Bivariate analysis was performed using chi-square test followed by multivariate logistic regression models. We included all variables with p-values less than 0.20 in the multivariate analysis. RESULTS Most (79.5%) of the pregnant and postpartum WLWH enrolled on ART, were urban residents. Over 2/3 were aged 30 years and older. Overall, 33.5% of respondents had poor ART adherence. Proportion of poor ART adherence was 19.4% among those with low WI, 44.4% in those with moderate WI, and 40.0% among those with high WI. Respondents with moderate household water insecurity had a greater odds of reporting poor ART adherence, as compared to those with low water insecurity (adjusted Odds ratio (aOR) = 2.76, 95%CI: 1.14-6.66, p = 0.024), even after adjusting for food insecurity. Similarly, respondents with high WI had a greater odds of reporting poor ART adherence, as compared to those with low water insecurity (aOR = 1.49, 95%CI: 0.50-4.48, p = 0.479), even after adjusting for food insecurity. CONCLUSION Water insecurity is prevalent among pregnant and postpartum WLWH and is a significant risk factor for poor ART adherence. Governments and other stakeholders working in HIV care provision should prioritize water security programming for WLWH along the HIV care continuum.
Collapse
Affiliation(s)
- Jerry John Nutor
- Department of Family Health Care Nursing, School of Nursing, University of California San Francisco, San Francisco, California, United States of America
| | - Jaffer Okiring
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Isaac Yeboah
- Institute of Work Employment and Society, University of Professional Studies, Accra, Ghana
| | - Rachel G. A. Thompson
- Language Center, College of Humanities, University of Ghana, Accra, Ghana
- Africa Interdisciplinary Research Institute, Accra, Ghana
| | - Pascal Agbadi
- Department of Sociology and Social Science Policy, Lingnan University, Hong Kong, China
| | - Edward Kwabena Ameyaw
- Institute of Policy Studies and School of Graduate Studies, Lingnan University, Hong Kong, China
| | - Monica Getahun
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, California, United States of America
| | - Wisdom Agbadi
- Africa Interdisciplinary Research Institute, Accra, Ghana
- Push Aid Africa, Accra, Ghana
| | - Thomas J. Hoffmann
- Department of Epidemiology and Biostatistics, and Office of Research, School of Nursing, University of California, San Francisco, San Francisco, California, United States of America
| | - Sheri D. Weiser
- Division of HIV, Infectious Diseases and Global Medicine, School of Medicine, University of California, San Francisco, San Francisco California, United States of America
| |
Collapse
|
4
|
Nutor JJ, Gyamerah AO, Alhassan RK, Duah HO, Thompson RGA, Wilson N, Harris O, Gutierrez J, Hoffmann TJ, Getahun M, Santos GM. Influence of depression and interpersonal support on adherence to antiretroviral therapy among people living with HIV. AIDS Res Ther 2023; 20:42. [PMID: 37386514 PMCID: PMC10308781 DOI: 10.1186/s12981-023-00538-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 06/20/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Poor adherence and under-utilization of antiretroviral therapy (ART) services have been major setbacks to achieving 95-95-95 policy goals in Sub-Saharan Africa. Social support and mental health challenges may serve as barriers to accessing and adhering to ART but are under-studied in low-income countries. The purpose of this study was to examine the association of interpersonal support and depression scores with adherence to ART among persons living with HIV (PLWH) in the Volta region of Ghana. METHODS We conducted a cross-sectional survey among 181 PLWH 18 years or older who receive care at an ART clinic between November 2021 and March 2022. The questionnaire included a 6-item simplified ART adherence scale, the 20-item Center for Epidemiologic Studies Depression Scale (CES-D), and the 12-item Interpersonal Support Evaluation List-12 (ISEL-12). We first used a chi-squared or Fisher's exact test to assess the association between these and additional demographic variables with ART adherence status. We then built a stepwise multivariable logistic regression model to explain ART adherence. RESULTS ART adherence was 34%. The threshold for depression was met by 23% of participants, but it was not significantly associated with adherence in multivariate analysis(p = 0.25). High social support was reported by 48.1%, and associated with adherence (p = 0.033, aOR = 3.45, 95% CI = 1.09-5.88). Other factors associated with adherence included in the multivariable model included not disclosing HIV status (p = 0.044, aOR = 2.17, 95% CI = 1.03-4.54) and not living in an urban area (p = 0.00037, aOR = 0.24, 95% CI = 0.11-0.52). CONCLUSION Interpersonal support, rural residence, and not disclosing HIV status were independent predictors of adherence to ART in the study area.
Collapse
Affiliation(s)
- Jerry John Nutor
- Department of Family Health Care Nursing, School of Nursing, University of California San Francisco, San Francisco, CA, USA.
| | - Akua O Gyamerah
- Department of Community Health and Health Behavior, University of Buffalo, Buffalo, NY, USA
| | - Robert Kaba Alhassan
- Centre for Health Policy and Implementation Research, Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
| | - Henry Ofori Duah
- College of Nursing, University of Cincinnati, Cincinnati, OH, USA
| | - Rachel G A Thompson
- Language Center, College of Humanities, University of Ghana, Accra, Ghana
- Africa Interdisciplinary Research Institute, Accra, Ghana
| | - Natalie Wilson
- Department of Community Health Systems, School of Nursing, University of California San Francisco, San Francisco, CA, USA
| | - Orlando Harris
- Department of Community Health Systems, School of Nursing, University of California San Francisco, San Francisco, CA, USA
| | - Jose Gutierrez
- Department of Family Health Care Nursing, School of Nursing, University of California San Francisco, San Francisco, CA, USA
| | - Thomas J Hoffmann
- Department of Epidemiology and Biostatistics, Office of Research, School of Nursing, University of California, San Francisco, San Francisco, CA, USA
| | - Monica Getahun
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Glenn-Milo Santos
- Department of Community Health Systems, School of Nursing, University of California San Francisco, San Francisco, CA, USA
| |
Collapse
|